Research progress on animal models of contrast-induced acute kidney injury / 中南大学学报(医学版)

Contrast-induced acute kidney injury (CI-AKI) refers to acute kidney injury that occurs after intravascular contrast media is applied. It is the third most common cause for acute renal failure in hospitalized patients and can cause severe renal impairment and adverse cardiovascular outcomes. In severe cases, it can even lead to the death of the patient. Due to its complicated pathogenesis, the pathogenesis of CI-AKI has not yet been elucidated. Therefore, it is of great significance to further study the pathogenesis for the prevention of CI-AKI. Moreover, a good animal model of CI-AKI is an important tool for in-depth research on the pathogenesis of acute kidney injury induced by contrast agents.

Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Objectives: This prospective, randomized study assessed short-term outcomes and safety of ultra-low contrast percutaneous coronary intervention(ULC-PCI) vs conventional PCI in high risk for contrast induced acute kidney injury(CI-AKI) patients presenting with acute coronary syndrome(ACS). Background: Patients at an increased risk of developing CI-AKI can be identified prior to PCI based on their pre-procedural risk scores. ULC-PCI is a novel contrast conservation strategy in such high risk patients for prevention of CI-AKI. Methods: 82 patients undergoing PCI for ACS were enrolled having estimated glomerular filtration rate(eGFR) < 60 ml/min/1.73 m2 and moderate to very high pre-procedural risk of developing CI-AKI as calculated by Maioli risk calculator. They were randomized into two groups of 41 patients each of ULCPCI (contrast volume patient's eGFR) and conventional PCI (contrast volume 3xpatient's eGFR). Primary end point was development of CI-AKI. Results: Baseline clinical and angiographic characteristics were similar between groups. Primary outcome of CI-AKI occurred more in patients of the conventional PCI group [7 (17.1%)] than in the ULC PCI group [(0 patients), p ¼ 0.012]. Contrast volume (41.02 (±9.8) ml vs 112.54 (±25.18) ml; P < 0.0001) was markedly lower in the ULC-PCI group. No significant difference in secondary safety outcomes between two study arms at 30 days. IVUS was used in 17% patients in ULC PCI. Conclusion: ULC-PCI in patients with increased risk of developing CI-AKI is feasible, appears safe, and has the potential to decrease the incidence of CI-AKI specially in resource limited setting such as ours where coronary imaging by IVUS is not possible in every patient.

The principles of ultra-low contrast percutaneous coronary intervention

Ultra-low contrast percutaneous coronary intervention (ULCPCI) can be performed electively in advanced chronic kidney disease. Engage guide catheter and advance guidewire into the coronary artery without using contrast. IVUS-guided PCI can reduce the contrast load. Perform co-registration of distal and proximal radio-opaque marker bands of intravascular ultrasound (IVUS) catheter. Deploy the stent at the target lesion under fluoroscopic guidance of these co-registered position of the IVUS-marking images. Complete the ULCPCI procedure with a final angiography using minimal contrast. Newer contrast sparing techniques and intravascular imaging technologies provide opportunities to perform ULCPCI efficiently with good results and the least complications

Astaxanthin attenuates contrast-induced acute kidney injury in rats by inhibiting dynamin-related protein 1-mediated mitochondrial fission through activating SIRT1 pathway / 中华肾脏病杂志

Objective:To investigate whether astaxanthin (AST) down-regulates dynamin-related protein 1 (Drp1) through activating the silent mating type information regulation 2 homolog-1 (SIRT1) signaling pathway, thereby attenuating contrast-induced acute kidney injury.Methods:Forty adult male Sprague-Dawley rats weighing 160-180 g were randomly divided into five groups: sham surgery group (Sham group), contrast medium injury group (CM group), astaxanthin-intervention group (AST+CM group), SIRT1 inhibitor Ex527 intervention group (Ex527+CM group), and astaxanthin combined with Ex527 intervention group (AST+Ex527+CM group). After 72 hours of modeling, heart blood was removed and kidney tissues were collected for follow-up testing. Serum creatinine (Scr), blood urea nitrogen (BUN), and oxidative stress-related indexes total superoxide dismutase (T-SOD) and malondialdehyde (MDA) were measured by biochemistry; hematoxylin and eosin staining was performed to observe the pathological changes in the kidney; mitochondrial morphology and number were observed by transmission electron microscopy; reactive oxygen species (ROS) levels were detected by ROS staining in frozen sections; TUNEL staining was performed to detect apoptosis level. The expression levels of SIRT1, p53, peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), Drp1 and apoptosis-related proteins Bcl-2 and Bax were detected by Western blotting.Results:(1) Compared with the CM group, Scr and BUN level were significantly lower, T-SOD level was higher and MDA level was lower in the AST+CM group, while T-SOD level decreased and MDA level increased after the combination of Ex527 (all P<0.05). (2) ROS expression was lower in the AST+CM group compared to the CM group and higher after the combination of Ex527 (both P<0.05). (3) The number of apoptotic cells was significantly reduced in the AST+CM group compared to the CM group and increased after the combination of Ex527 (both P<0.05). (4) The protein expression levels of SIRT1, PGC-1α and Bcl-2 were increased and the protein expression levels of p53, Drp1 and Bax were decreased (all P<0.05) in the AST+CM group compared with the CM group, and the protein expression levels of SIRT1, PGC-1α and Bcl-2 were decreased and the protein expression levels of p53, Drp1 and Bax were increased when Ex527 was combined (all P<0.05). Conclusion:Astaxanthin can inhibit Drp1-mediated mitochondrial fission by activating the SIRT1 pathway, thereby reducing contrast-induced acute kidney injury in rats.

Effect of calcium dobesilate in preventing contrast-induced nephropathy in patients with diabetes and chronic kidney disease

OBJECTIVES: This study assessed the protective effect of calcium dobesilate against contrast-induced nephropathy (CIN) after coronary angiography (CAG) or percutaneous coronary intervention (PCI) in patients with diabetes and chronic kidney disease (CKD). METHODS: A total of 130 patients with diabetes and CKD estimated glomerular filtration rate: 30-90 mL/min/1.73m2 were enrolled and included in the analysis. They were divided into experimental (n=65) and control groups (n=65). Patients in the experimental group were administered oral calcium dobesilate (500 mg) three times daily for 2 days before and 3 days after the procedure. The serum creatinine (SCr), cystatin C (Cys C), and neutrophil gelatinase-associated lipocalin (NGAL) levels were measured before and after the procedure. RESULTS: The mean SCr level at 24h after the procedure was found to be significantly lower in the experimental group than in the control group (79.1±19.6 μmol/L vs. 87.0±19.3 μmol/L, p=0.023). However, the Cys C and NGAL levels were not significantly different between the two groups at all measurement time points (all p>0.05). The incidence of CIN defined by the SCr level was significantly lower in the experimental group than in the control group (3 [4.6%] vs. 13 [20.0%], p=0.017). However, the incidence of CIN defined by the Cys C level was not statistically different between the two groups (7 [10.8%] vs. 7 [10.8%], p=1.000). CONCLUSIONS: This study revealed that calcium dobesilate has no preventive effect against CIN in patients with diabetes and CKD.

Efficacy of short-term moderate or high-dose statin therapy for the prevention of contrast-induced nephropathy in high-risk patients with chronic kidney disease: systematic review and meta-analysis

Although previous studies have indicated that statin therapy can effectively prevent the development of CIN, this observation remains controversial, especially in high-risk patients. A meta-analysis was performed to evaluate the efficacy of statin pretreatment for preventing the development of CIN in patients with chronic kidney disease (CKD) and to determine its effectiveness in various subgroups. We searched the online databases PubMed, EMBASE, and the Cochrane Library. RCTs that involved the comparison of the short-term moderate or high-dose statin pretreatment with placebo for CIN prevention in CKD patients undergoing angiography were included. The primary outcome was CIN prevalence. Seven RCTs comprising 4256 participants were investigated in this analysis. The risk of developing CIN in patients pretreated with statins was significantly lower than that in patients pretreated with placebo (RR=0.57, 95%CI=0.43-0.76, p=0.000). The SCr values of the statin group, when analyzed 48h after angiography were lower than those of the placebo group ((SMD=-0.15, 95% CI=-0.27 to -0.04, p=0.011). In the subgroup analysis, statin pretreatment could decrease the risk of CIN in CKD patients with DM (RR=0.54, 95% CI=0.39-0.76, p=0.000), but not in CKD patients without DM (RR=0.84, 95% CI=0.44-1.60, p=0.606). The efficacy of atorvastatin for preventing CIN was consistent with that observed with the use of rosuvastatin. The risk ratios (RR) were 0.51 (95% CI=0.32-0.81, p=0.004) and 0.60 (95% CI=0.41-0.88, p=0.009), respectively. Our study demonstrated that statin pretreatment could prevent the development of CIN in CKD patients. However, subgroup analysis demonstrated that statin pretreatment, despite being effective in preventing CIN in patients with CKD and DM, was not helpful for CKD patients without DM. Rosuvastatin and atorvastatin exhibited similar preventive effects with respect to CIN.

Medios de contraste intravascular en tomografía computada y resonancia magnética: lo que el clínico necesita saber / Intravascular contrast media in computed tomography and magnetic resonance imaging: what the clinician needs to know

Introducción: los medios de contraste en radiología se utilizan para mejorar la visibilidad de los tejidos normales y patológicos, lo que permite distinguirlos entre sí mediante la modificación de las características de imagen de los tejidos. Permite no solo una mejor evaluación morfológica de las lesiones, sino también una evaluación cinética funcional y de contraste. Objetivos: presentar una revisión actualizada sobre los medios de contraste intravascular en radiología, con énfasis en los conceptos que el médico clínico no radiólogo debe tener presente al momento de su indicación. Métodos: se realizó una revisión bibliográfica de literatura radiológica relevante sobre medios de contraste intravascular: clasificación, indicaciones, contraindicaciones y precauciones que debe adoptar el médico clínico. Resultados: aunque los medios de contraste en radiología tienen un excelente perfil de seguridad, su uso no está exento de riesgos y debe basarse en criterios apropiados después de una evaluación clínica exhaustiva, ponderando riesgos y beneficios para cada paciente individual. Conclusión: la comunicación entre médicos tratantes, nefrólogos y radiólogos es funda-mental para evaluar casos clínicos complejos o que requieran consideraciones especiales al momento de indicar la administración de un medio de contraste intravascular.

Introduction: Imaging contrast media are used to enhance the visibility of normal and pathologic tissues, allowing distinction of one another by modifying tissue imaging characteristics. This allows both enhanced morphologic assessment of lesions and also contrast kinetics evaluation. Objectives: To present an updated review on intravascular imaging contrast media. Emphasis will be put on useful concepts that general physicians must take into account when indicating contrast-enhanced imaging studies.Methodology: A bibliographic review of relevant imaging literature on intravascular contrast media was performed: classification, appropriate indications, contraindications, and tips for proper use by the general physician. Results: Although imaging contrast media have an excellent safety profile, its use is not risk-free and must be based on appropriateness criteria applied after a thorough clinical evaluation, balancing the risks and benefits for each patient. In particular, intravascular contrast media, such as those based on iodine for computed tomography and gadolinium chelates for magnetic resonance imaging, must be used with caution. Conclusion: Effective communication between radiologists and referring physicians is key in the evaluation of complex cases that require protocol adjustments when considering the use of intravascular contrast media for imaging studies.

Studies on the differences of major adverse cardio- And cerebrovascular events and the acute renal injury caused by contrast agents in Chinese patients of different ages receiving iodoxadol for PCI / 解放军医学杂志

Objective To explore the differences of the main adverse cardio- and cerebrovascular events (MACCE) and contrast-induced acute kidney injury (CIAKI) in Chinese patients of different ages who receiving percutaneous coronary intervention (PCI) therapy with iodoxanol. Methods A total of 3042 patients from 30 centers in China were enrolled in present IMPERIAL study (China clinical trial register: ChiCTR-ONC-13003733) from Oct. 30, 2013 to Oct. 7, 2015. Enrolled patients were observed for 3 days during hospitalization, and followed-up for one month after discharge. All the enrolled patients were divided into three groups according to their age: patients in group A aged less than 65 years (n=1748), in group B aged 65-75 years (n=828), and in group C were elder than 75 years (n=466). The primary end point was the incidence of MACCE (composite outcomes events of revascularization of target lesions, stroke, stent thrombosis, cardiac death and nonfatal myocardial infarction) and CIAKI in hospital 72 h after PCI. The secondary end point was the incidence of MACCE 72 h-30 d after PCI. Results Primary end point events among the three groups were shown as below: There was no statistical significance in revascularization of target lesions, stroke, stent thrombosis, cardiac death and nonfatal myocardial infarction (P>0.05). The incidence of CIAKI in group A, group B and group C [7.1% (121/1702), 7.8% (63/806), and 10.7%(49/458), respectively] showed statistical difference (P=0.016). And the incidence of cardiac death was 0% (0/1748) in group A, 0.12% (1/828) in group B, and 0.43% (2/466) in group C, showed significant difference (P=0.031). While the incidence showed no statistical significance (P>0.05) of revascularization of target lesions, stroke, stent thrombosis, and nonfatal myocardial infarction among the three groups. Conclusions Iodioxadol is safe and feasible for coronary intervention in Chinese patients of different ages, only CIAKI and the incidence of cardiogenic death after discharge increased with age.

Impact of femoral or radial approach on acute renal injury induced by repeated contrast medium in patients with coronary heart disease / 中华心血管病杂志

Objective: To investigate the effects of femoral approach versus radial approach on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients with coronary heart disease, who received twice contrast agents within a short interval. Methods: A total of 322 patients with coronary heart disease, who admitted to the General Hospital of Northern Theater Command from January 2010 to January 2015, were included in this retrospective analysis. All patients exposed to contrast agents twice within 30 days. The patients were divided into two groups according to the approach of interventional operation: radial artery group (n=235) and femoral artery group (n=87). Serum creatinine (SCr) values were detected at 48 and 72 hours post procedure. Endpoint events were CI-AKI, which was defined as SCr increased>0.5 mg/dl (44.2 μmol/L) or relative ratio ((postoperative SCr-preoperative SCr)/preoperative SCr×100%>25%) within 72 hours after contrast agent use after excluding other causes. Clinical characteristics and the incidence of CI-AKI were compared between the two groups, multivariate logistic regression analysis was used to detect the risk factors of postoperative CI-AKI in these patients. Results: The proportion of smoking, PCI history, STEMI patients and levels of fibrinogen, fasting blood glucose, troponin T was significantly higher in femoral artery group than in radial artery group (all P<0.05). The interval between two procedure sessions was significantly longer in the femoral artery group than in the radial artery group (P=0.001). The incidence of CI-AKI tended to be higher in femoral artery group than in radial artery group after the first operation (18.6% (16/87) vs. 11.9% (28/235), P=0.133). CI-AKI incidence after the second operation was similar between the two groups (P>0.05). Multivariate logistic regression analysis showed that interventional approach was not an independent risk factor for postoperative CI-AKI in patients with coronary heart disease undergoing interventional procedures twice within 30 days (P>0.05);STEMI (OR=2.854, 95%CI 1.100-7.404, P=0.031) and diuretics use (OR=4.002, 95%CI 1.470-10.893, P=0.007) were independent risk factors for CI-AKI after the first operation. Conclusion: There is no correlation between the risk of CI-AKI and interventional approaches in patients with coronary heart disease who undergo interventional surgery twice within 30 days.

Urinary semaphorin 3A as an early biomarker to predict contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention

Contrast-induced acute kidney injury (CI-AKI) is a serious complication of diagnostic coronary angiograph and percutaneous coronary intervention (PCI). However, the exact pathophysiological mechanisms underlying CI-AKI development are largely unknown. The present study examined whether urinary semaphorin 3A levels predict the development of CI-AKI in patients undergoing PCI. This study enrolled 168 patients with stable angina undergoing elective PCI. Serial urine samples, obtained at baseline and 2, 6, 12, 24, 36, and 48 h post-PCI were analyzed by semaphorin 3A and neutrophil gelatinase-associated lipocalin (NGAL) ELISA kit. AKI was defined as an increase in serum creatinine beyond 50% according to the RIFLE classification system. Receiver operator characteristic (ROC) curve analyses identified optimal semaphorin 3A and NGAL values for diagnosing CI-AKI. CI-AKI occurred in 20 of 168 patients. There were no significant differences in the baseline clinical characteristics and angiographic findings between non-AKI patients group and AKI patients group. Both urinary semaphorin 3A and NGAL levels significantly increased at 2 and 6 h post-PCI. ROC analysis showed that the cut-off value of 389.5 pg/mg semaphorin 3A at 2 h post-PCI corresponds to 94% sensitivity and 75% specificity and the cut-off value of 94.4 ng/mg NGAL at 2 h post-PCI corresponds to 74% sensitivity and 82% specificity. Logistic regression showed that semaphorin 3A levels at 2 and 6 h post-PCI were the significant predictors of AKI in our cohort. Urinary semaphorin 3A may be a promising early biomarker for predicting CI-AKI in patients undergoing PCI.

Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention / 中华医学杂志(英文版)

Background@#Mounts of studies have shown that low estimated glomerular filtration rate (eGFR) is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury (CI-AKI) in a Chinese population who underwent an emergency percutaneous coronary intervention (PCI).@*Methods@#Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint (including nonfatal myocardial infarction, revascularization, stroke, and all-cause death) at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.@*Results@#A total of 1061 patients were included and the overall CI-AKI rate was 22.7% (241/1061). The separate rates were 77.8% (7/9) in Group 1 (eGFR ≥120 ml·min·1.73 m), 26.0% (118/454) in Group 2 (120 ml·min·1.73 m> eGFR ≥90 ml·min·1.73m), 18.3% (86/469) in Group 3 (90 ml·min·1.73 m> eGFR ≥60 ml·min·1.73 m), 21.8% (26/119) in Group 4 (60 ml·min·1.73 m> eGFR ≥30 ml·min·1.73 m), and 40.0% (4/10) in Group 5 (eGFR <30 ml·min·1.73 m), with statistical significance (χ = 25.19, P < 0.001). The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing (the higher the level of eGFR, the higher the CI-AKI occurrence in case of eGFR ≥60 ml·min·1.73 m). The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences (χ = 16.26, P = 0.009 at 6-month follow-up, and χ = 49.05, P < 0.001 at 12-month follow-up). The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients.@*Conclusions@#High level of eGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.

Contrast-Induced Acute Kidney Injury after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage

PURPOSE: Contrast-induced acute kidney injury (CI-AKI) is associated with poor outcomes after percutaneous coronary intervention. However, CI-AKI has rarely been evaluated within the neurovascular field. The aim of this study was to investigate the incidence and clinical implication of CI-AKI after coil embolization in patients with an aneurysmal subarachnoid hemorrhage (aSAH). MATERIALS AND METHODS: Between January 2005 and March 2016, 192 patients who underwent coil embolization were enrolled in this study. CI-AKI was defined as an increase from baseline serum creatinine concentration of >25% or >0.5 mg/dL within 72 hours after coil embolization. A poor clinical outcome was defined as a score of ≥3 on the modified Rankin Scale at one-year post-treatment. RESULTS: A total of 16 patients (8.3%) died as a result of medical problems within one year. CI-AKI was identified in 14 patients (7.3%). Prominent risk factors for one-year mortality included CI-AKI [odds ratio (OR): 16.856; 95% confidence interval (CI): 3.437–82.664] and an initial Glasgow Coma Scale (GCS) score ≤8 (OR: 5.565; 95% CI: 1.703–18.184). A poor clinical outcome was associated with old age (≥65 years) (OR: 7.921; 95% CI: 2.977–21.076), CI-AKI (OR: 11.281; 95% CI: 2.138–59.525), an initial GCS score ≤8 (OR 31.02; 95% CI, 10.669–90.187), and a ruptured aneurysm (p=0.016, OR: 4.278) in posterior circulation. CONCLUSION: CI-AKI seems to be an independent predictor of the overall outcomes of aSAH after endovascular treatment.

A multicenter prospective registration study of iodixanol in the treatment of major adverse cardiovascular and cerebrovascular events and contrast-induced acute kidney injury, in Chinese patients with chronic kidrey disease undergoing percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To evaluate the infl uence of iodixanol on Chinese patients who had chronic kidney disease(CKD) and received percutaneous coronary intervention complicated with major adverse cardiovascular and cerebrovascular events(MACCE) and contrast-induced acute kidney injury(CIAKI). Methods From 30th October 2013 to 7th October 2015, 3042 patients were enrolled in 30 centers in China. Patients were monitored in the hospital for 3 days and followed-up at 1 month. Patients were divided into chronic kidney disease group(n=105)and non chronic kidney disease group (n=2937) according to whether the patient has chronic nephropathy or not.The primary end point was the incidence rate of MACCE (re-revascularization of target lesions, stroke, stent thrombosis,cardiac death and myocardial infarction) and CIAKI in hospital 72 hours after PCI. The secondary end point was the incidence rate from 72 hours to 30 days post-PCI. Resuits (1)There were obvious differences between the two groups in baseline demographic date including age,BMI,comorbidities of hypertension,congestive heart failure, dyslipidemia,diabetes mellitus,peptic ulcer,ischemic stroke,previous use of antihypertensive drugs, diuretics,lipid-regulating drugs,hypoglycemic drugs,antiplatelet drugs and anticoagulants(all P<0.05).(2) There were obvious differences the CKD and non-CKD groups in perioperative date including operative route,preoperative hydration volume,postoperative hydration volume,total hydration volume,degree of postoporation lesion stenosis, contrast media used and machine injection rate(all P<0.05).(3)There were signifi cant diff erences between the two groups in the percentage of prescription of β-blocker,lipid-regulating drugs and antiplatelet drugs after PCI(all P<0.05).(4)There was not statistical diff erences between two groups in MACCE incidence in hospital and from 72 hours to 30 days post-PCI(P>0.05). (5)There was not statistical diff erences between two the groups in CIAKI incidence in hospital (P>0.05). Conclusions Iodixanol had no signifi cant eff ect on the incidence of MACCE and CIAKI in Chinese chronic kidney disease patients and non-CKD patients who received PCI.

Characteristics of the serum creatinine change patterns in patients with acute myocardial infarction undergoing emergent percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To investigate the characteristics of the serum creatinine change patterns and its clinical signifi cance in patients with acute myocardial infarction(AMI)undergoing emergent percutaneous coronary intervention(PCI). Methods Two hundred and ninety-three consecutive ST elevation myocardial infarction(STEMI) patients who underwent emergent PCI were retrospectively grouped into the descending type,increasing type,stable type,U curve type and converse U curve type according to the dynamic changes serum creatinine in within 72h after PCI. The characteristics of diff erent patterns relationship of the respective pattern to the Mehran risk score,the serum creatinine changes between admission to 1 month after PCI,and the incidence of adverse events were analyzed.Results The proportion of the 5 pattern groups was 9.9%(decending type),17.7(increasing type),47.1%(stable type),4.1%(U curve type)and 21.2%(converse U curve type),respectively. The incidence of adverse events was higher in the increasing type,stable type and converse U curve type compared to the other 2 types in 1 month after PCI. Hypotension before admission and volume expansion therapy were more common in the groups of descending type and U curve type while diuretics were more frequently used in converse U curve type than descending type. The decline of creatinine from admission to 1 month after PCI were 57.9% in descending type and 27.3% in U curve type. Conclusions The dynamic change of serum creatinine presents with multiple patterns in patients undergoing emergent PCI. Hypotension before admission,volume expansion therapy,and the use of diuretics may aff ect the value of serum creatinine. The serum creatinine level at admission seems not suitable for baseline assessment to evaluate the risk of contrast-induced acute kidney injury in some patients.

Development of preprocedure nomogram for predicting contrast-induced acute kidney injury after coronary angiography or percutaneous coronary intervention / 中国介入影像与治疗学

Objective To establish a preprocedure nomogram for predicting contrast-induced acute kidney injury (CI-AKI) after coronary angiography (CAG) or percutaneous coronary intervention (PCI).Methods Clinical data of 245 patients underwent CAG or PCI were collected.CI-AKI prediction nomogram integrated preprocedural predictors was established with clinical characteristics associated with CI-AKI which were selected with the LASSO regression model,and CI-AKI risk scores were calculated.The ROC curve was constructed to calculate the risk score cutoff.Results The occurrency of CI-AKI was 13.88％ (34/245).Sex,diabetes mellitus,lactate dehydrogenase level,high-sensitivity C-reactive protein,drinking years,chronic kidney disease (CKD),stage of CKD,stroke,acute myocardial infarction as well as systolic blood pressure were significant risk factors.The efficiency of CI-AKI nomogram was good,and the cutoff value of risk score was-1.953.Conclusion The novel nomogram can be used to preprocedurally predict the risk of CI-AKI after CAG or PCI treatment.

Comparison of iodixanol and iohexol on contrast-induced acute kidney injury in acute myocardial infarction patients undergoing emergent percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To compare the incidence of contrast-induced acute kidney injury(CI-AKI) following iso-osmolar iodixanol or low-osmolar iohexol administration in patients with acute myocardial infarction(AMI)undergoing emergent percutaneous coronary intervention(PCI). Methods The study was a prospectiverandomized controlled study.Consecutive patients with AMI were assigned to either the iodixanol group or the iohexol group randomly after they were categorized in different group according to the infarcted walls(inferior and anterior infarction)indicated by electrocardiogram. The primary end point was the incidence of CI-AKI,which is defined as serum creatinine(sCr)increase>25% or>0.5 mg/dl(44 μmol/L)from baseline witin 72 hours. Results Two hundred ninety-seven patients were enrolled and allocated to the iodixanol group(n=149)or the iohexol group(n=148),and CI-AKI occurred in 22.1% of patients in the iodixanol group and 16.9% of patients in the iohexol group (95% confidence interval –14.2% to 3.8%,P for noninferiority<0.002). The incidence of CI-AKI was higher in the anterior infarction group than in the inferior infarction group(21.4% vs. 11.6%,P<0.01). Conclusions In patients with AMI who underwent emergent PCI,iohexol was not inferior to iodixanol on the incidence of CI-AKI,and it is reasonable to avoid selection bias for assigning patients into inferior and anterior infarction group according to the infarcted walls for the future CI-AKI related clinical study.

Comparison of iodixanol and iohexol on contrast-induced acute kidney injury in acute myocardial infarction patients undergoing emergent percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To compare the incidence of contrast-induced acute kidney injury(CI-AKI) following iso-osmolar iodixanol or low-osmolar iohexol administration in patients with acute myocardial infarction(AMI)undergoing emergent percutaneous coronary intervention(PCI). Methods The study was a prospectiverandomized controlled study.Consecutive patients with AMI were assigned to either the iodixanol group or the iohexol group randomly after they were categorized in different group according to the infarcted walls(inferior and anterior infarction)indicated by electrocardiogram. The primary end point was the incidence of CI-AKI,which is defined as serum creatinine(sCr)increase>25% or>0.5 mg/dl(44 μmol/L)from baseline witin 72 hours. Results Two hundred ninety-seven patients were enrolled and allocated to the iodixanol group(n=149)or the iohexol group(n=148),and CI-AKI occurred in 22.1% of patients in the iodixanol group and 16.9% of patients in the iohexol group (95% confidence interval –14.2% to 3.8%,P for noninferiority<0.002). The incidence of CI-AKI was higher in the anterior infarction group than in the inferior infarction group(21.4% vs. 11.6%,P<0.01). Conclusions In patients with AMI who underwent emergent PCI,iohexol was not inferior to iodixanol on the incidence of CI-AKI,and it is reasonable to avoid selection bias for assigning patients into inferior and anterior infarction group according to the infarcted walls for the future CI-AKI related clinical study.

Experimental study on attenuation of contrast-induced acute kidney injury by enhancing autophagy in rats / 国际生物医学工程杂志

Objective To evaluate the effects of autophagy on contrast-induced acute kidney injury (CI-AKI) in rat models.Methods Eighteen male rats were divided into control group (Con),CI-AKI group (CI-AKI) and rapamycin-pretreated group (Rapa).In the CI-AKI group,CI-AKI was induced by intraperitoneal injection of iohexol (12.25 g/kg I).In the Rapa group,rapamycin was given by intraperitoneal injection with a dose of 5 mg/(kg ·d) for consecutive 7 days,and then injected with iohexol (12.25 g/kg I).Rats in the Con group were injected by the same dose of saline.The renal function,renal histopathology,and the levels of LC3 Ⅱ / Ⅰ and Beclin-1 as well as catalase (CAT) in the kidneys of rats were evaluated one day after the injection.Results Compared with the Con group,serum creatinine in the CI-AKI group was significantly increased ((239.93±27.00)μmol/L) vs (51.70±10.59) μmol/L,P＜0.05),and the content of CAT was significantly decreased ((14.86 ± 0.32) U/mg vs (18.72±1.46) U/mg,P＜0.05).In the CI-AKI group,renal tubules were severely injured,and the expression of autophagy-related proteins LC3 Ⅲ / Ⅰ and Beclin-1 in renal tissue was increased.Compared with the CI-AKI group,the pretreatment of rapamycin (Rapa group) increased the expression of LC3 Ⅱ / Ⅰ and Beclin-1 as well as the content of CAT in renal tissue ((17.62±1.86) U/mg vs (14.86±0.32) U/mg,P＜0.05),and inhibited the increase of contrast-induced serum creatinine ((187.62± 47.76) μmol/L vs (239.93±27.00) μmol/L,P＜0.05) and renal tubule injury.Conclusions The results showed that contrast administration can induce autophagy activation in kidneys,while enhancing autophagy can attenuate contrast-induced oxidative stress injury and related renal injury.

Multicenter clinical study of the predictive value of neutrophil gelatinase-associated lipocalin for contrast-induced acute kidney injury after emergency percutaneous coronary intervention in patients with relative normal renal function / 实用医学杂志

Objective To explore the predictive value of neutrophil gelatinase associated lipocalin (NGAL) for contrast-induced acute kidney injury (CI-AKI) after emergency percutaneous coronary interventions (PCI) in patients with relative normal renal function.Methods A total of 73 patients with relative normal renal function undergoing PCI were enrolled in this prospective multicenter clinical study.Serum NGAL was measured by point-of-care test.Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of NGAL for CI-AKI.Results CI-AKI occurred in 5 patients (6.85％).The concentration of NGAL was higher in the CI-AKI group than in the non-CI-AKI group.ROC curve indicated that the area under the receiver operating characteristic was 0.755,0.761 and 0.809,respectively.Conclusions Serum NGAL at baseline,4 h and 8 h after procedure are served as a good biomarker for early diagnosis of CI-AKI after PCI.Therefore,NGAL might become an early and quick marker for CI-AKI in the future.

Predictive value of cystatin C level for contrast-induced acute kidney injury and poor long-term outcomes after cardiac catheterization / 实用医学杂志

Objective To investigate the predictive value of preprocedural cystatin C level for contrast-in-duced acute kidney injury (CI-AKI) and poor long-term outcome after cardiac catheterization. Methods One thou-sand one hundred and fifty-four patients underwent cardiac catheterization were enrolled in Guangdong general hos-pital. The level of serum cystatin C was determined at 24 hours pre-operation. A 2-year follow up was performed for each patient. Preprocedural cystatin C level was compared between patients with or without CI-AKI. The cystatin C quartiles were compared between patients with incidence of CI-AKI and patients with adverse in-hospital outcomes. Analyses of the receiver operating characteristic curves (ROC) were performed to evaluate the predictive value and cutoff level of cystatin C level for CI-AKI. The log-rank test and Cox regression analyses were also performed to in-vestigate the correlation between cystatin C level and poor long-term outcomes. Results CI-AKI occurred in 42 patients (3.6%). The cystatin C level was significantly higher in the CI-AKI group than that in the non-CI-AKI gu-oup (1.76 ± 1.05 vs 1.20 ± 0.50 mg/L, P=0.001). Patients with higher cystatin C level also had higher risk of CI-AKI and adverse in-hospital outcomes. ROC and Youden index showed that 1.3 mg/L cystatin C of was a fair dis-criminator for CI-AKI, but not significantly different from the Mehran CI-AKI score (AUC, 0.75 vs 0.76, P =0.874). After adjusting for other known CI-AKI risk factors, cystatin C level over 1.3 mg/L remained significantly associated with CI-AKI. During the long-term follow-up , the patients with cystatin C level over 1.3 mg/L were at a higher risk of all-cause mortality and MACEs (P < 0.001). Concusions A preprocedural cystatin C level over 1.3 mg/L was a good predictor of CI-AKI and poor long-term outcomes after cardiac catheterization.